By not expanding Medicaid, Maine misses out. But Obamacare still has benefits

JONATHAN BACHMAN | REUTERS

JONATHAN BACHMAN | REUTERS

Registered Nurse Rebecca Moak poses for a photo in trauma center of the University of Mississippi Medical Center in Jackson, Mississippi October 4, 2013.

November 18, 2013 3:10 pmUpdated: November 18, 2013 3:11 pm

What is Maine missing out on as a result of Gov. Paul LePage’s decision earlier this year to veto a bill that would extend Medicaid coverage to 50,000 low-income adults and preserve it for 25,000 more?

Beyond the primary drawback that some of Maine’s poorest will miss out on the chance to gain access to the health care they deserve, Maine is missing out on a chance to extract maximum benefit from a law meant to make high-quality health care affordable to a broader segment of the population.

A study released Monday puts that reality into perspective, even if it does it in an inexact way. The website WalletHub ranked the states and Washington, D.C., by how much they’re expected to benefit from the Affordable Care Act, the Obama administration’s health care reform law.

Maine came out 16th. If Maine and every other state agreed to expand Medicaid — an optional component of the health care law that many Republican-led states are rejecting — its ranking would jump to No. 2, behind West Virginia.

Although Maine is among those states deciding against a Medicaid expansion, other provisions of the Affordable Care Act — not considering the law’s flubbed and chaotic rollout — stand to benefit the Pine Tree State more than others.

By one measure considered by WalletHub, Maine ranks second for the average expected savings due to the Affordable Care Act’s limits on the amount an insurance plan can allow its subscribers to pay out of pocket through deductibles and copayments. The law limits the amount to $6,350 for an individual and $12,700 for a family. Based on the amount Maine residents pay out of pocket for medical care right now, the average savings would be $2,098.97, according to WalletHub.

Some of the benefit would come from lower deductibles and co-payments; 15 percent of those enrolled in individual market plans in 2011 had deductibles of $15,000, according to Gorman. And the benefit would still accrue despite Gorman’s projections that, due to the health reform law, 57 percent of those who purchase their insurance through the newly deployed online health insurance exchanges will see their premiums rise by an average of 37 percent — even after the law’s tax subsidies are applied.

Maine’s ranking was also helped by the fact that the state is home to a disproportionate number of small businesses — the fourth highest number per capita, according to WalletHub — that could qualify for the Affordable Care Act’s small business tax credit, which is meant to offset health coverage costs for small businesses with fewer than 25 full-time employees who earn, on average, less than $50,000.

Maine ranks fifth in the nation for its rate of emergency room visits per capita, and that’s another reason WalletHub flagged Maine as a state that stood to benefit most from Obamacare.

Indeed, a 2006 study by the Muskie School of Public Service at the University of Southern Maine found that emergency room use in the state was about 30 percent higher than the national average and that it varied significantly within the state. And the reasons for so many visits to the emergency room for care — colds, sore throats, dental disease and diaper rash — could be addressed more effectively in cheaper settings.

While WalletHub concludes that insuring more Maine residents would lead to reduced emergency room use, the research doesn’t back that up entirely. In Maine, Medicaid recipients are more likely than those with private insurance and those with no insurance to use the emergency room.

That’s why along with expanding Medicaid, Maine needs to overhaul its Medicaid program so those covered by the public program don’t have an incentive to visit the emergency room for care and so health care providers have an incentive to steer patients away from the ER.

It’s our hope that the Affordable Care Act — once the failed rollout is in the past — won’t only lead to expanded coverage by Medicaid and other forms of insurance, but to expanded coverage that’s effective in providing high-quality care and containing costs.